DYSFUNCTION DISORDER: Snapshots Taken as Gospel

The young mother was in danger of losing her child when she met with a psychologist in May of 2014. She had been living in a Manhattan shelter for victims of domestic violence, and New York City’s child welfare agency was considering taking the child from the woman, according to the woman’s lawyer. The psychologist was supposed to conduct an assessment and file a report, a finding that could end up before a Brooklyn Family Court judge who would decide the family’s fate.

The interview lasted barely an hour. The psychologist’s subsequent one-page report stated that the mother was “cognitively limited,” and that her “mental status exam” reflected “primitive and irrational decision-making.” The report, signed by a psychiatrist, also noted that the parenting abilities of the mother, an immigrant from Central America, were suspect because of the kinds of foods she chose to feed the baby.

The child was taken from the mother’s custody immediately after the evaluation, and the removal was approved by a judge days later.

In late 2015, a father in the Bronx lost all chance at custody of his child as the result of another similar evaluation. He had met with a psychologist for an hour shortly after the birth of his child, according to the man’s attorney. The psychologist did not ask a single question about the man’s potential to be a parent, and never saw him in the presence of his newborn. He was instead given what the psychologist called an “abbreviated IQ test,” the attorney said. The subsequent report to Family Court concluded the father’s “cognitive limitations” left him unfit to care for his child.

The mental health professionals in both cases had been recruited by Montego Medical Consulting, a for-profit company under contract with New York City’s child welfare agency. For more than a decade, Montego was paid hundreds of thousands of dollars a year by the city to produce thousands of evaluations in Family Court cases — of mothers and fathers, spouses and children. Those evaluations were then shared with judges making decisions of enormous sensitivity and consequence: whether a child could stay at home or if they’d be safer in foster care; whether a parent should be enrolled in a counseling program or put on medication; whether parents should lose custody of their children altogether.

In 2012, a confidential review done at the behest of frustrated lawyers and delivered to the administrative judge of Family Court in New York City concluded that the work of the psychologists lined up by Montego was inadequate in nearly every way. The analysis matched roughly 25 Montego evaluations against 20 criteria from the American Psychological Association and other professional guidelines. None of the Montego reports met all 20 criteria. Some met as few as five. The psychologists used by Montego often didn’t actually observe parents interacting with children. They used outdated or inappropriate tools for psychological assessments, including one known as a “projective drawing” exercise.

The reviewers warned Family Court judges that they should regard the reports from Montego with extreme caution. They encouraged the city’s child welfare agency — known as the Administration for Children’s Services, or ACS — to consider ending its relationship with the company.

But the review was kept secret, and Montego continued for another two years under contract with ACS. In fact, the agency sent more families to Montego in the ensuing years than it ever had before, setting aside millions for the company to use to provide more mental health evaluations.

Lauren Shapiro, the director of Brooklyn Defender Service’s family defense practice, said her organization had worked with dozens of families broken apart in large part because of Montego’s evaluations.

“We were shocked they were even being used by the court given that they didn’t follow the basic minimum standards for evaluating parents,” said Shapiro, who helped initiate the confidential 2012 survey.

Jama Adams, Montego’s clinical director, didn’t contest the findings of the 2012 review at the time, nor does he now. He said he and the clinicians he had hired had done the best they could, and had capably served untold numbers of families not captured in the limited review, before the city terminated its dealings with Montego in December of 2015.

Today, Adams looks back on the entire arrangement with the city as a kind of empty promise. The city, he said, had never been willing to spend the money it would have taken to produce high-quality mental health assessments. Meaningful examinations of parents or children would require taking weeks, not days, spending thousands of dollars, not hundreds. The city, he said, had set Montego up to fail. Adams said that failure had been shared by the judges in Family Court who relied on Montego‘s reports despite their clear limitations.

“These were snapshots,” Adams said of the reports. “But people started taking them as gospel.”